Assessment of Multiple Risk Outcomes, Strengths, and Change with the START:AV: A Short-Term Prospective Study with Adolescent Offenders

Abstract

The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV; Nicholls, Viljoen, Cruise, Desmarais, & Webster, 2010; Viljoen, Cruise, Nicholls, Desmarais, & Webster, in preparation) is a clinical guide designed to assist in the assessment and management of adolescents’ risk for adverse events (e.g., violence, general offending, suicide, victimization). In this initial validation study, START:AV assessments were conducted on 90 adolescent offenders (62 male, 28 female), who were prospectively followed for a three-month period. START:AV assessments had good to excellent inter-rater reliability and strong concurrent validity with Structured Assessment of Violence Risk in Youth assessments (SAVRY; Borum, Bartel, & Forth, 2006). START:AV risk estimates and Vulnerability total scores predicted multiple adverse outcomes, including violence towards others, offending, victimization, suicidal ideation, and substance abuse. In addition, Strength total scores inversely predicted violence, offending, and street drug use. During the three-month follow-up, risk estimates changed in at least one domain for 92% of youth, and 27% of youth showed reliable changes in Strength and/or Vulnerability total scores (reliable change index, 90% confidence interval; Jacobsen & Truax, 1991). While these findings are promising, a strong need exists for further research on the START:AV, the measurement of change, and on the role of strengths in risk assessment and treatment planning.

Keywords:

• risk assessment
• strengths
• dynamic
• violence
• victimization
• self-harm
• suicide
• substance abuse

Acknowledgments

J. L. Viljoen's work on this project was supported by a Michael Smith Foundation for Health Research Career Investigator Award, and a grant from the British Columbia Mental Health and Addictions Research Network (held jointly with the sixth author). S. L. Desmarais's work on this project was supported by the National Institute on Drug Abuse (P30DA028807, PI: Roger H. Peters). T. T. L. Nicholls’ work is supported by a Michael Smith Foundation for Health Research Career Investigator Award and a Canadian Institutes of Health Research New Investigator Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Notes

The START:AV was implemented mid-way through this larger study. Thus, the sample size of the existing analyses is smaller than that of the larger study.

The addition of the General Offending risk estimate to the adult START is anticipated in version 2.0.

The original SRO Total score had a skewness of 2.30 and a kurtosis of 5.79. In contrast, normal distributions have skewness and kurtosis values between 0 and +/− 1 (Osborne, 2002). The square root transformation produced distributions that more closely approximated a normal distribution (i.e., skewness and kurtosis for transformed scores ranged between 0 and +/− 1.3).

The RCI was calculated by: RC = where X₁ is the START:AV strength or vulnerability total score at baseline and X₂ is the total score at the 3-month follow-up (Jacobsen & Truax, 1991). S_diff is the standard error of measurement of the two scores and is calculated as: S_diff = sqrt[2(S_E)²], and S_E (SEM) was calculated as: SEM = s_x(sqrt[1- r_xx]), where s_x is the standard deviation of scores and r_xx is the reliability of a test.

Given that few youth were taking any medications (n = 12, 13.3%), we did not include this item in the calculation of the START:AV Strength and Vulnerability total scores for this particular sample. This is unlikely to have changed our results, given that only 2 youth received scores of 2 for strength or vulnerability on this item.